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This study explores how Lean was deployed in several hospitals in the Apulia region in Italy over 3.5 years.

An exploratory qualitative design was drawn up based on semi-structured interviews.

The drivers of Lean in hospitals were to increase patient satisfaction and improve workplace well-being by eliminating non-value-add waste. The participants highlighted three key elements of the pivotal implementation stages of Lean: introduction, spontaneous and informal dissemination and strategic level implementation and highlighted critical success and failure factors that emerged for each of these stages. During the introduction, training and coaching from an external consultant were among the most impactful factors in the success of pilot projects, while time constraints and the adoption of process analysis tools were the main barriers to implementation. The experiences of the Lean teams strongly influence the process of spontaneous dissemination aided by the celebration of project results and the commitment of the departmental hospital heads.

Lean culture can spread to allow many projects be conducted spontaneously, but the Lean paradigm can struggle to be adopted strategically. Lean in healthcare can fail because of the lack of alignment of Lean with leadership in healthcare and with their strategic vision, a lack of employees' project management skills and crucially the absence of a Lean steering committee.

The absence of managerial expertise and a will to support Lean implementation do not allow for systemic adoption of Lean. This is one of the first and largest long-term case studies on a Lean cross-regional multi-hospital application in healthcare.

The purpose of this paper is to review the roles of human resource management (HRM) specialists in the contemplation and implementation of innovation in employing organisations and workplaces.

The authors review some of the literature and practice in this field as well as 11 other articles that are included in this special issue.

The authors propose six research questions. First, are HRM specialists analysing relevant trends and their implications for the future of work and the workforce? Second, are HRM specialists enabling employing organisations to identify and enable innovative ideas? Third, to what extent are HRM specialists leading partnership arrangements with organised labour? Fourth, what is the role of HRM specialists in creating inclusive work environments? Fifth, how should HRM specialists change to foster enterprise performance, intrapreneurship, agility, creativity and innovation? Sixth, to what extent is there an HRM function for line managers in coordination with HRM specialists in engendering innovation around “change agent” roles?

The authors argue that HRM specialists should embrace and enable innovation. The authors challenge HRM specialists to consider how they can contribute to facilitating innovation. The paper proposes further research on HRM and range of associated stakeholders who, together, have responsibility for innovating in the design and delivery of HRM to enrich our knowledge of HRM and workplace innovations.